Alcoholism center rejects the AA model

When their son had to take a medical leave from college, New Yorkers Jack and Wendy knew they — and he — needed help with his binge drinking.

Carrie Wilkens, who works with substance abuse patients at the Center for Motivation and Change, in New York, June 5, 2014. Several New York area programs, including CMC, are challenging the abstinence approach of Alcoholics Anonymous and using a combination of therapy, prescription drugs and personal responsibility to tame substance abuse. (Kirsten Luce/The New York Times)

Their son’s psychiatrist, along with a few friends, suggested Alcoholics Anonymous. He had a disease, and to stay alive, he’d have to attend AA meetings and abstain from alcohol for the rest of his life, they said.

But instead, they turned to a group of psychologists who specialize in treating substance use and other compulsive behaviors at the Center for Motivation and Change.

The center is part of a growing wing of addiction treatment that rejects the AA model of strict abstinence as the sole form of recovery for alcohol and drug users.

It uses a suite of techniques that provide a hands-on approach to emotional and behavioral problems, rather than having abusers forever swear off the substance — a particularly difficult step for young people.

“The traditional language often sets parents up to feel they have to make extreme choices: Either force them into rehab or detach until they hit rock bottom,” said Dr. Carrie Wilkens, a psychologist who helped found the CMC 10 years ago. “Science tells us those formulas don’t work very well.”

When parents issue edicts, demanding an immediate end to all substance use, it often lodges the family in a harmful cycle, said Dr. Nicole Kosanke, a psychologist at the CMC. Tough love, she said, often backfires by further damaging connections to people to whom the child is closest.

The center’s approach includes motivational interviewing, a goal-oriented form of counseling; cognitive behavioral therapy, a short-term form of psychotherapy; and harm reduction, which seeks to limit the negative consequences of substance abuse. The psychologists also support the use of anti-craving medications like naltrexone, which block the high of using the substance.

A 2002 study in the journal Addiction showed that motivational interviewing, cognitive behavioral therapy and naltrexone, often used together, are far more effective in stopping or reducing drug and alcohol use than the faith-and-abstinence-based model of AA and other 12-step programs. Results of an updated study are not yet out.

Jack and Wendy’s son is in his early 20s. Friends suggested that if he did not attend AA, the only thing Jack and Wendy could do was attend Al-Anon.

“The implication was that there was no other solution,” Jack said.

On a warm evening last month, about a dozen parents gathered to hear Kosanke describe the center’s program for families, which goes by the acronym CRAFT, for Community Reinforcement and Family Training. It rejects, she said, the use of three words: “addict,” “alcoholic” and “enabling,” terms that help perpetuate unhealthy behaviors.

She prefers the terms favored by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, which says that patients suffer from “alcohol use disorder” or “substance abuse disorder,” terms that convey a spectrum of severity.

“There are real downsides to labeling a child with a lifetime identity, when that truly may or may not turn out to be the case,” Kosanke said.

CMC doctors say teenagers and young adults are neurologically, psychologically, socially and legally different from adults, and have different treatment needs.

In fact, a majority of college binge drinkers do not go on to become alcohol dependent, said Dr. Stanton Peele, a Brooklyn psychologist who is a critic of the AA model.

“Isn’t it more encouraging to know that most people are going to outgrow these habits than to think they’re going to have a disease for the rest their lives?” Peele asked. “The data show that the odds are in your favor.”

Last modified: July 15, 2014
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